Leveraging primary healthcare institutions for the deployment of automated external defibrillators: a geospatial optimization analysis in Deyang, China.
Resuscitation Plus · 2026-06-11 · Observational study
Abstract
AIM: To analyze the spatial and epidemiological characteristics of out-of-hospital cardiac arrest (OHCA) in Deyang, China (2021-2023), quantify the supply-demand coverage gap in current automated external defibrillator (AED) placement, and evaluate a geospatial optimization strategy embedding AEDs in 24/7 accessible outdoor cabinets at primary healthcare institutions (PHCIs). METHODS: We integrated data on OHCA cases, existing AEDs, PHCIs, and demographics. Temporal variations were assessed via descriptive epidemiology, while spatial heterogeneity was characterized via Global/Local Moran's I and Getis-Ord Gi* hotspot analysis. A network analysis model integrating the Gaussian Two-Step Floating Catchment Area (Ga2SFCA) method and the Maximal Covering Location Problem (MCLP) was constructed using PHCIs as candidate nodes based on road network distance. Optimization was simulated under two scenarios: complete redistribution and incremental expansion. RESULTS: The study included 3273 OHCA cases. Significant temporal variations were observed, with peak incidence during morning hours and public holidays. Spatial autocorrelation indicated intensifying OHCA clustering from 2021 to 2023 (Moran's I: 0.38-0.49, P < 0.01). Furthermore, spatial analysis revealed a stable 'core-periphery' structure, with Jingyang District identified as a consistent high disease burden hotspot. A marked supply-demand coverage gap was observed: residential areas accounted for 82.22% of cases but only 6.29% of AED deployments. Existing AEDs covered only 31.87% of historical OHCAs within a 500-m road network distance. The new Optimized Model for Network Analysis demonstrated that achieving >50% coverage required 100 additional AEDs under a complete redistribution strategy, versus 200 under an incremental expansion strategy. CONCLUSION: The distribution of OHCA incidence exhibits distinct epidemiological patterns, significant spatial clustering, and a marked disconnect from current AED placement. A geospatial optimization strategy leveraging the extensive network of PHCIs significantly enhances coverage efficiency. This "PHCI-embedded" model provides a cost-effective framework for establishing resilient cardiac arrest response systems in resource-constrained urban settings.
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Automated external defibrillator · Urban
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